Anaemia: a public health concern?

Anaemia is defined as insufficient haemoglobin (Hb) or red blood cells. Additional causes include other nutritional deficiencies (vitamins B-12, B-6 and A, riboflavin, and folic acid), chronic disease and inflammation, conditions that cause blood loss or haemolysis (e.g, parasitic infections such as hookworm or malaria or hemorrhage) (Domellof et al 2002). Nutritional anaemia is of public health concern in India. Though reduced intake of iron is a major aetiological factor, low intake or an imbalance in the consumption of other haematopoietic nutrients, their utilization; increased nutrient loss and/or demand also contribute to nutritional anaemia. In India, cereals and millets form the bulk of the dietaries and are major sources of non-haeme iron.The intake of iron is less than 50 per cent of the recommended dietary allowance (RDA) and iron density is about 8.5 mg/1000 Kcal. It is now well established that iron bioavailability from habitual Indian diets is low due to high phytate and low ascorbic acid/iron ratios. These factors determine iron bioavailability and the RDA. The other dietary factors affecting iron status are inadequate intake of folic acid and vitamins B12, A, C and other vitamins of the B-complex group. Chronic low grade inflammation and infections, and malaria also contribute significantly to iron malnutrition. Food-based approaches to increase the intake of iron and other haematopoietic nutrients through dietary diversification and provision of hygienic environment are important sustainable strategies for correction of iron deficiency anaemia. This is possible if there is accessibility, availability and affordability to diversify food to enhance absorbability of iron in the general population. For the vulnerable groups food fortification and food supplementation are important alternatives that complement food-based approaches to satisfy the iron needs.